6.5 Disease Of Oesophagus

Question 1

Name & describe 4 common oesophageal dysfunction symptoms

Answer 1

1. Heartburn - episodic substernal pain. Worsen after meal. Improve by antiacid.

2. Non-cardiac chest pain - GERD

3. Dysphagia - [A] difficult initiating swallow (neuromuscular)
- [B] obstructive

4. Odenophagia - pain/burning sensation when swollowing

Question 2

Mechanisms of swallowing (stages)

Answer 2

**1. Oral **- preparation (chew, bolus); transport/propulsive (tongue)
**2. Pharyngeal **- epiglottis goes post and down; upper oesophageal sphincter relax
3. Oesophageal- Bolus down oesophagus with peristalsis

Question 3

Name 3 oesophageal motility disorders

Answer 3

1. Achalasia
2. Diffuse oesophageal spasm (frequent non-peristaltic contractions)
3. Hyopmotility disorders (decreased contraction wave <30mmHg + incomplete peristalsis)

Question 4

GERD
Definition
Types
Complications
Factors associated
Pathophysiology

Answer 4

Def - reflux of gastric contents

Types - LES dys, Transient LE relax, Hiatal hernia

Complications- Eosophogitis, Barett’s syndrome, Dysplasia, Neoplasms

Factors associated - Preg, obesity, fat, chocolate, coffee, alcohol, large meals, smoking, drugs, HH, systemic sclerosis, after achalasia treatment

Pathophysiology - Abnormal LES, increased abdominal pressure (preg, obese)

Question 5

Infective oesophagitis
Viral - Types; symptoms
Bacterial - types

Answer 5

Viral
- Types: Candida, HSV, CMV, EBV, HPV
- S ymp: nauses, vomit, odynophagia, fever, rertrostrenal pain, GI bleeding (HPV)

Bacterial - Staph aureus, staph epidermis, strep strains

Question 6

How do you characterise Eosinophilic oesophagistis?

Answer 6

• Dense esopageal eosinophilia (_>15 eos/HPV)
• Severe squamous hyperplasia
  -Upper GI symp
• Overlap with GERD

SYMPTOMS - Intermittent dysplasia, food impaction